食管癌筛查队列操作流程与建设标准方案探讨

癌症防治工作的重点在于一级预防和二级预防,通过健康教育引起人们对疾病的重视、自觉改变不良行为习惯、主动参加定期体检是防治癌症性价比最高的措施之一。食管癌作为我国疾病负担较重的恶性肿瘤之一,定期筛查和早诊早治是该病防治工作的重点。而队列研究有助于了解食管癌的自然史和危险因素、识别食管癌高危人群。本研究拟从危险因素调查、疾病监测、生物样本信息搜集等方面对食管癌多维动态随访共享队列的建设规范进行探讨,为今后建立规范统一的食管癌筛查队列研究操作流程和建设标准提供参考。     

老年尸检机化性肺炎临床病理分析

目的 探讨老年尸体解剖中遇到的机化性肺炎的临床病理特点及其可能的原因。方法 从1980—2003年635例老年人尸检资料中检出95例机化性肺炎,观察机化性肺炎的形态特点,并对其临床资料和影像学变化进行回顾分析。结果 机化性肺炎大多数病灶小、散在,经常出现在主要肺部疾病附近,不同病变相伴的机化性肺炎其病变特点也略有差别;95例机化性肺炎周围的主要肺部疾病有：(1)化脓性肺炎及肺脓肿以及慢性复发性肺炎(36例);(2)感染性疾病(真菌、病毒等17例);(3)吸人性肺炎(16例);(4)放射性肺炎(5例);资料还显示慢性胸膜炎、肺不张也常与机化性肺炎相伴。机化性肺炎肺部病变影像学表现呈多样性。结论 老年尸检中机化性肺炎是常见的伴发病变,与多种疾病相关,各种原因伴发的机化性肺炎形态学上大致相似。在相关因素分析中认为老年性机化性肺炎主要与细菌、真菌、病毒等感染有关;吸入性及放射性肺炎等也常伴发机化性肺炎。影像学上肺部感染患者长期不消散的阴影需考虑到出现机化性肺炎的可能。     

羟苯磺酸钙对血液流变及血栓形成作用的实验研究

目的研究国产抗糖尿病微血管病变药物羟苯磺酸钙对血小板聚集、血栓形成、血液粘滞度、红细胞脆性以及出血时间等影响 ,为临床应用提供理论依据。方法与结果羟苯磺酸钙0.15、0.21和0.30g/kg,灌胃 ,每日1次 ,连续3d ,可明显抑制ADP和胶原引起的大鼠血小板聚集 ,其抑制率与对照组比较有显著性差异(P<0.01) ;明显降低大鼠血液粘滞度及改善大鼠红细胞中间脆性 ,其作用与对照组比较均有显著性差异(P<0.01)。羟苯磺酸钙0.15、0.30和0.60g/kg灌胃 ,一次给药 ,可明显抑制大鼠颈动静脉旁路血栓形成 ,其作用呈剂量依赖性 ,与对照组比较有显著性差异(P<0.01 ,P<0.05) ;对于小鼠 ,羟苯磺酸钙0.15、0.30和0.60g/kg 灌胃 ,一次给药 ,可明显对抗胶原诱导的血栓形成 ,其降低血栓引起的死亡和偏瘫率呈剂量依赖性 ,与对照组比较有显著性差异(P<0.01 ,P<0.05) ;能明显延长小鼠出血时间 ,与对照组比较有显著性差异(P<0.01)。结论羟苯磺酸钙对于糖尿病微血管病变相关的血液学指标有改善作用。     

慢性马兜铃酸肾病动物模型的建立及其意义

目的探讨建立马兜铃酸引起的大鼠慢性肾间质纤维化动物模型.方法将雌性wistar大鼠分为马兜铃酸组与对照组.马兜铃酸组大鼠腹膜内注射马兜铃酸5mg@kg-1@d-1共16周,开始用药后8、12、16、20、24周分别处死6只大鼠.对照组大鼠(5只)腹膜内注射生理盐水2ml/d,共16周,24周时处死.两组动物处死时分别留取血、尿、肾组织标本,分别作生化、病理(光镜,免疫荧光,电镜)等方面的检查及应用电脑软件测定肾小管-间质面积.结果马兜铃酸组大鼠用药后16、20、24周体重明显低于对照组;用药后16周血尿素氮、血清肌酐明显高于对照组,24周时肾功能损伤进一步加重.光镜检查可见马兜铃酸组大鼠有明显肾小管-间质损伤,16周时肾小管面积明显增加,管腔面积明显小于对照组;24周时出现明显肾小管萎缩,肾小管面积明显缩小,而肾间质面积明显增加,肾间质呈多灶性纤维化.电镜检查16周时肾小管上皮细胞胞质内初级溶酶体、次级溶酶体明显增加,部分肾小管上皮细胞刷状缘消失;20、24周时可见胞质内次级溶酶体和髓样小体堆积.结论建立了慢性马兜铃酸肾病动物模型.马兜铃酸具有慢性肾毒性作用,可引起大鼠慢性肾间质纤维化.     

法乐四联症儿童肥厚右心室细胞瞬间外向钾电流的研究

目的观察压力增高导致的人肥厚心室组织离子通道的特性.方法应用酶解分离技术从法乐四联症(F4)患儿的心脏右室得到单个细胞,应用膜片钳全细胞记录技术观察了细胞Ito1的特征.结果将钙电流阻断后,去极化至-20mV～+60mV时均可记录到Itn1,激活后电流衰减速度不随去极化程度的增强而改变,在0、20、40、60mV时分别为123ms±6ms、131ms±10ms、122ms±6ms、122ms±6ms,去极化至60mV时的电流密度为4.7pA/pF±0.8pA/pF,半数最大激活电位为4.1mV±2.8mV,半数最大失活电位出现在-41mV±4mV,失活后再激活的恢复时间常数为83ms±4ms.这种电流可被10mM4-AP基本抑制.结论肥厚的人右室细胞存在Itn1,通道动力学特征与成人心房肌细胞类似.     

~(18)氟标记脱氧葡萄糖正电子发射断层脑显像对癫痫患者致痫灶的定位和手术疗效的预测价值

目的　探讨18氟标记脱氧葡萄糖 (18F FDG)正电子发射断层 (PET)脑显像皮质代谢改变与癫痫患者致痫灶的关系 ,及其对手术方式选择和疗效预测的价值。方法　经手术治疗的 72例癫痫患者 (男 49例 ,女 2 3例 ,平均年龄 2 4岁 )术前行18F FDGPET脑显像并与同期磁共振 (MRI)、视频脑电图 (VEEG)结果进行比较 ,全部进行了疗效随访 (3～ 2 4个月 ,平均 15个月 ) ,其中 2 0例术后复查了18F FDGPET脑显像。结果　 72例患者术前PET显像均有皮质代谢改变 ,1例表现发作期高代谢 ,71例表现发作间期低代谢。18F FDG代谢改变检出率高于MRI,其定位定侧准确性高于VEEG ,但多发低代谢灶不一定全是致痫灶。术后FDG显像有助于判断低代谢灶性质。皮质低代谢灶合并同侧丘脑和 /或对侧小脑代谢减低 ,术前术后显像对比表明系功能性变化。术前FDGPET图像分型与手术方式和术后疗效相关。结论　手术前后FDGPET图像对比有助于评价代谢改变与癫痫灶的关系 ,代谢改变图型可帮助临床医生选择手术方式和预测疗效     

The role of sexual related Y gene detection in the diagnosis of patients with gonadal dysgenesis

Objective To clarify the role of sexual related Y (SRY) gene detection in the diagnosis of gonadal dysgenesis.Methods Sixteen cases of gonadal dysgenesis were included in this study: 5 with androgen insensitivity syndrome, 1 with 17-α-hydroxylase deficiency, 4 with true herm aphrodite, 2 with 45,X/46,XY gonadal dysgenesis, 1 with 45,X gonadal dysgenesis, 1 with XY pure gonadal dysgenesis, 1 with testicular regression, and 1 XY fema le who gave birth to a normal baby. SRY gene was detected by using polymerase c hain reaction (PCR) in blood and gonad samples and by direct sequencing of the S RY motif. Results Among the 16 cases, 15 were blood SRY positive, among which 13 (86.7%) showed t he presence of testicular tissue, and 2 showed ovaries without testicular tissue . One SRY negative case showed the presence of testicular tissue. In 3 cases, SRY detection in gonadal tissue correlated with pathological findings but not wi th blood karyotype. The correlation between peripheral blood SRY and the pathol ogy of the gonads was 81.25% and the correlation between the presence of periph eral blood Y chromosome and pathology of the gonads was 68.75%. Sequencing of the SRY motif in an XY female who gave birth to a normal baby showed no mutatio n.Conclusions SRY detection is more sensitive and specific than blood karyotype in the predic tion of the presence of testicular tissue. Peripheral blood karyotype does not necessarily reflect gonadal type. There may be testicular related factors other than the SRY gene.     

Percutaneous balloon aortic valvuloplasty in the treatment of congenital valvu lar aortic stenosis in children

Objective To assess the effect of the balloon valvuloplasty for congenital valvular aortic stenosis (AS) in children.Methods A total of 27 (mean age 6.09 years) children with AS accepted the treatment of percutaneous balloon aortic valvuloplasty (PBAV).The ratios of balloon/valve were 0.95±0.08 for 19 cases of typical AS and 1.00±0.11 for 8 cases of hyp oplastic AS.The patients were evaluated by the gradients across aotic valves i n pre- and post-PBAV and by echocardiogram during the follow-up period.Results Fifteen of 19 （78.9%）cases of typical AS had a better outcome and the gradien t of the remaining 4 cases (26.7%) had increased after follow-up (ΔP&gt;50 mm Hg).Four of 8 (50.0%) cases of hypoplastic AS had satisfactory responses and the gradient of the remaining 3 cases (75.0%) rose.There was no moderate to s evere aortic insufficiency (AI). Conclusion The balloon aortic valvuloplasty provides safe and significant hemodynamic and c linical improvement in pediatric patients.The outcome of PBAV for typical AS is better than for hypoplastic AS.     

Optimal management of postpartum hemorrhage

目的　讨论产后出血干预治疗的合理方案。方法　回顾性分析 15例行干预性治疗的严重产后出血的病人的临床特点及方法。结果　 15例患者中子宫切除者 9例 ,行动脉栓塞治疗 7例 (2例切除子宫后又行栓塞治疗 ) ,行病灶挖除术 1例。需行干预性治疗的产后出血的原因依次为 :DIC ,子宫动 -静脉瘘及血管畸形 ,胎盘异常 ,子宫肌瘤及子宫裂伤。结论　应针对产后出血的不同原因、部位及性质选择合理有效的干预治疗。合理的治疗方案是抢救病人生命 ,保留生育功能 ,尽可能减少创伤的关键。     

COMBINED INTRAOPERATIVE ILIAC ARTERY STENTS AND FEMORO-POPLITEAL BYPASS FOR MULTILEVEL ATHEROSCLEROTIC OCCLUSIVE DISEASE

Objective. To review our preliminary experience and evaluate our early results of a combined intraopemtive iliac angioplasty and stenting with infrainguinal revascularization in multilevel atherosclerotic occlusive disease. Methods. From July 1999 to April 2000, intraoperative iliac angiOplasty and stenting combined with simultaneous femoro-pepliteal bypass were pedormed on 12 lower extremities of 10 patients suffering from multilevel athemsclemtic occlusive disease. There were 8 men and 2 women, average 72 years. The indicationsf or procedures included disabling claudication in 3 and rest pain in 7 patients. Results. Eleven iliac angioplasty and stem procedures combined with simultaneous 9 femoro-popliteal by-pass and 3 femoro-femoral-popliteal bypass were performed in 12 limbs of 10 patients. Angioplasty and stem placement was technically successful in all patients. One contralateral femoral-popliteal bypass was failure after femoro-femoral-popliteal bypass. There were no additional instances of procedural or postoperative morbidity or mortality. Mean follow-up was 5 months (range 1 -10 months). During the follow-up period, one femoro-infrapoplitealgraft became occluded after 7 months and above-knee amputation was required. The cumulative primary patencyrate of stented iliac arteries, femoro-femoral bypass grafts and femoro-popliteal bypass grafts were 100% (11/11), 100% (3/3) and 90. 9% (10/11) in the follow-up period, respectivdy. The amputation rate was 8. 3%(1/12). Conclusions. Intraoperative iliac artery PTA and stent placement can be safely and effectively pedormed simultaneously with infrainguinal revascularization for multilevel atherosclerotic occlusive disease by skilled vascular surgeon, using a portable C ann fluoroscopy in the operating room. Furthermore, iliac artery PTA and stenting was valuable adjunct to distal bypass either to improve inflow and outflow, or to reduce the extent of traditionalsurgical intervention, and also, any angioplasty and stenting-related complications can be immediately corrected as well.